Citation Nr: 9812409
Decision Date: 04/21/98 Archive Date: 05/06/98
DOCKET NO. 97-06 385 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Portland,
Oregon
THE ISSUES
1. Entitlement to service connection for a heart disorder.
2. Entitlement to a total rating for compensation based on
individual unemployability.
REPRESENTATION
Appellant represented by: Oregon Department of Veterans'
Affairs
ATTORNEY FOR THE BOARD
John Kitlas, Associate Counsel
INTRODUCTION
The veteran served on active duty from March 1941 to June
1946. He was held as a prisoner of war (POW) from April 1942
to August 1945. This matter is before the Board of Veterans’
Appeals (Board) on appeal from rating decisions by the
Department of Veterans Affairs (VA) Regional Office (RO) in
Portland, Oregon. In a February 1996 rating decision, the RO
denied service connection for ischemic heart disease
secondary to service-connected beriberi. In a September 1996
rating decision, the RO denied entitlement to compensation
based upon individual unemployability. Both issues have been
certified for appeal to the Board.
CONTENTIONS OF APPELLANT ON APPEAL
The veteran contends that his heart disorder is secondary to
his service-connected beriberi. As a former prisoner of war,
the veteran maintains that he is entitled to presumptive
service connection for his heart disorder. The veteran also
contends that the extent of his service-connected
disabilities significantly impaired his ability to work, and
forced him to retire. Further, he maintains that the extent
of these disabilities prevents him from obtaining current
gainful employment. Therefore, the veteran believes he is
entitled to a total disability rating based upon individual
unemployability.
DECISION OF THE BOARD
The Board, in accordance with the provisions of 38 U.S.C.A.
§ 7104 (West 1991 & Supp. 1997), has reviewed and considered
all of the evidence and material of record in the veteran's
claims file. Based on its review of the relevant evidence in
this matter, and for the following reasons and bases, it is
the decision of the Board that the preponderance of the
evidence is against the claim of service connection for a
heart disorder. It is also the decision of the Board that
the preponderance of the evidence supports the claim of
entitlement to compensation based upon individual
unemployability.
FINDINGS OF FACT
1. All available relevant evidence necessary for an
equitable disposition of the veteran’s appeal has been
requested or obtained by the RO.
2. The veteran currently has a combined service-connected
disability evaluation of 80 percent based upon the following:
post-traumatic stress disorder (PTSD), evaluated as 30
percent disabling; arthritis, cervical spine, with limitation
of motion, evaluated as 20 percent disabling; beriberi with
malnutrition, muscle fatigue, hypoactive triceps and biceps,
evaluated as 20 percent disabling; bursitis, left shoulder,
with degenerative joint disease, evaluated as 20 percent
disabling; bursitis of the right shoulder, evaluated as 20
percent disabling; and traumatic arthritis of the lumbar
spine, evaluated as 20 percent disabling. The veteran also
has noncompensable disability ratings for abrasions to the
right knee and head, dengue fever, malaria, pellagra,
dupuytren’s contracture of both hands, left finger
disability, avitaminosis, and amoebic dysentery.
3. A VA cardiologist’s report was issued in February 1996 to
clarify the conflicting diagnoses regarding the veteran’s
current heart condition. After reviewing the veteran’s
claims file and the conducting a medical examination, it was
the conclusion of the VA cardiologist that the veteran does
not currently have coronary artery disease.
4. The veteran was employed with the Standard Insurance
Company from February 1970 to April 1996. However, it
appears that the veteran worked, at the most, on a part-time
basis from 1986 to April 1996.
5. There is no objective evidence which specifically refutes
the veteran’s contention that the extent of his service-
connected disabilities significantly impaired his ability to
work, and forced him to retire.
CONCLUSIONS OF LAW
1. As the medical evidence does not show that the veteran
currently has coronary artery disease or ischemic heart
disease, the veteran is not entitled to service connection
for a heart disorder. 38 U.S.C.A. §§ 1110, 1112(b), 5107
(West 1991 & Supp. 1997); 38 C.F.R. §§ 3.303, 3.307(a),
3.309(c) (1997).
2. The criteria for a total rating based on individual
unemployability due to service-connected disabilities has
been met. 38 U.S.C.A. § 5107; 38 C.F.R. §§ 3.321, 3.340,
3.341, 4.16 (1997).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
Heart Disorder
In a March 1948 rating decision, the veteran received a
combined disability rating of 20 percent for the following:
anxiety reaction, evaluated as 10 percent disabling,
effective February 10, 1948; beriberi residuals, manifested
by under nutrition and muscular development fatigue, etc.,
evaluated as 10 percent disabling, effective February 10,
1948; and a 0 percent (noncompensable) disability rating for
abrasion of the right knee and head. The disability rating
for beriberi was increased to 20 percent in an October 1950
rating decision, resulting in a combined rating of 30
percent. This rating decision also assigned a 0 percent
(noncompensable) disability rating for amoebic dysentery.
The veteran sought to reopen his claim for service-connected
disabilities as a former POW in August 1994. Among other
things, the veteran sought entitlement to service connection
for ischemic heart disease secondary to service-connected
beriberi.
In conjunction with this claim, private medical records were
obtained from the Good Samaritan Hospital and Medical Center.
These records show that the veteran was first seen in 1985
for complaints of chest pain. It was reported that the
veteran had a number of positive coronary risk factors.
Although he had not had clinical hypertension, he was noted
to have blood pressure of 130/100 and a cholesterol level of
290. Until January 1985, he had been a cigarette smoker of
two to three packs a day for forty-seven years.
Additionally, he had a positive family history of both his
mother and uncle dying of coronaries. A CT scan was
performed, resulting in a diagnosis of aortic arch aneurysm.
A retrograde left heart catheterization, left ventricular
cine angiograph, coronary arteriography, and arch aortography
were performed on the veteran in December 1985. This
procedure revealed normal left ventricular contractility,
normal coronary artery, and dilated ectatic arch of the aorta
without pure aneurysm formation.
The veteran was hospitalized in April 1986 for the following
procedures: resection of aortic ductus diverticulum aneurysm
and Dacron patch repair. Cardiovascular examination revealed
a regular rate and rhythm, with “normal S1 and S2.” No
murmurs, clicks or rubs were found.
Subsequent medical records from October 1988 show a history
of arterial aneurysms, including an aortic aneurysm repaired
two and one-half years earlier, and an abdominal aortic
aneurysm repaired in September 1988. The veteran was
admitted in October 1988 for repair of a right popliteal
artery aneurysm. EKG at admission showed normal sinus rhythm
with no acute changes. The radiologist report found, among
other things, that the heart size was normal, and that there
was no active chest disease.
The veteran was treated again in January 1991. This was
reported to be the veteran’s fourth admission to the Good
Samaritan Hospital and Medical Center, and that he had a
somewhat complicated cardiovascular history. It listed how
the veteran was evaluated in 1985 for episodes of chest pain
and was found to have an aortic ductus diverticulum aneurysm,
which was repaired in April 1986; the September 1988
treatment for an abdominal aneurysm; and the October 1988
treatment for a right popliteal artery aneurysm. The
veteran’s condition had been stable until he began to
experience burning chest pain with belching on New Year’s
Day. Examination showed blood pressure in the right arm as
130/70, and 120/70 in the left arm. The examiner opined that
the veteran could have an insidious graft infection, or a
possible pulmonary process, or gastric or coronary disease.
Chest x-rays were ordered. The radiologist reported normal
coronary arteries; normal ventricular contractility; and a
tortuous, dilated thoracic aorta with no evidence of aneurysm
or leak. Additionally, a left heart catheterization,
coronary arteriogram and supravalvular aortogram were
performed to rule out coronary artery disease. Following
this procedure, the surgeon concluded that there was no
angiographic evidence of dissection of the aortic repair,
there were normal coronary arteries, and mildly decreased
left ventricular contractility.
A VA cardiovascular examination was afforded to the veteran
in December 1994. When asked about any history of heart
trouble, the veteran stated “not to my knowledge.” He had
not had any leg edema, dyspnea, daytime or nocturnal, and he
reportedly quit smoking 10 years earlier. The medical
history included his past treatment for all of the aneurysms
listed above. Examination of the heart revealed no apparent
enlargement; tones were good; no murmurs were heard; and
there was regular sinus rhythm with one aberrant heart beat.
Based upon the veteran history and his own findings, the
examiner concluded that the veteran almost certainly had
beriberi as a POW. However, this condition does not per se
lead to later heart disease, ischemic or otherwise. In the
present case, the veteran has not had a diagnosis of a heart
disorder. The veteran probably had a degree of coronary
atherosclerosis, considering his age and the fact that he has
had other arterial disease, but insufficient to produce
symptoms of significant or functional compromise. Chest x-
rays and an electrocardiogram were also afforded to the
veteran with this examination. The radiologist’s report
stated that the heart was not enlarged, and there was no
active pulmonary disease or signs of congestive failure. The
electrocardiogram showed normal sinus rhythm with occasional
premature supraventricular complexes, but otherwise normal
ECG.
A general VA examination was afforded to the veteran in
September 1995. Regarding his ischemic heart disease claim,
the veteran reported that he had never been told anything was
wrong with his heart. Moreover, he did not report any
cardiac symptoms and specifically denied anginal pain. The
examination revealed that the heart was not apparently
enlarged; tones were good; no murmurs were heard; and no
peripheral edema. There was fairly frequent mild
irregularities, approximately 4-5 per minute, that were
suggestive of atrial premature contractions. Based upon
these findings, the VA examiner diagnosed status post
resection of thoracic aortic aneurysm; status post resection
of abdominal aortic aneurysm; and status post resection of
right popliteal aneurysm. The examiner specifically found
that the veteran “does not have any symptoms pointing to
ischemic heart disease.” Further, the examiner commented
that while it is true that arterial aneurysm are (with rare
exceptions) a result of atherosclerosis, as is ischemic heart
disease, one may be present without the other. The two
conditions are associated but not directly related to one
another.
The veteran was also afforded a VA POW examination in October
1995. At this examination, the veteran reported that he was
told that he had heart disease nine years earlier, manifest
at the time by chest pains. The examiner noted that the
December 1994 electrocardiogram showed normal sinus rhythm
with occasional premature supraventricular complex; otherwise
normal. Examination showed the veteran’s blood pressure was
155/76, pulse 75 and regular good heart tones. The examiner
found no evidence of bruits or cardiomegaly. The heart tones
were slightly distant at the apex. There was normal sinus
rhythm. Based upon his findings, the examiner diagnosed,
among other things, generalized arteriosclerosis with
ischemic heart disease and aneurysms (aortic ductus
diverticulum aneurysm, abdominal aortic aneurysm, right
popliteal aneurysm) secondary, now postop aneurysm repair x
3. The examiner then ordered chest x-rays and a new
electrocardiogram be performed. The electrocardiogram
reported normal sinus rhythm with occasional premature
ectopic complexes; ST abnormality; possible digitalis effect;
and abnormal ECG. The radiologist report compared the
current findings with the December 1994 examination and found
no interval change, including no change in the cardiovascular
structures. Furthermore, no active pulmonary disease or
signs of congestive failure were noted.
The RO issued a rating decision in December 1995 regarding
the veteran’s various August 1994 claims. The RO found that
the veteran was entitled to an increased rating of 30 percent
for PTSD, formerly diagnosed as anxiety reaction; the veteran
was not entitled to an increased rating for beriberi with
malnutition, and it remained at 20 percent; nor was he
entitled to an increased (compensable) rating for amoebic
dysentery. Service connection was granted for arthritis,
cervical spine, with limitation of motion, evaluated as 20
percent disabling; bursitis, left shoulder, with degenerative
joint disease, evaluated as 20 percent disabling; bursitis of
the right shoulder, evaluated as 20 percent disabling; and
traumatic arthritis of the lumbar spine, evaluated as 20
percent disabling. The veteran was also assigned
noncompensable disability ratings for abrasions to the right
knee and head, dengue fever, malaria, pellagra, dupuytren’s
contracture of both hands, left finger disability, and
avitaminosis. The veteran was not entitled to service
connection for any of his reported aneurysms. Due to the
conflicting diagnoses, the RO deferred final adjudication of
the ischemic heart disease claim until the exact nature of
the veteran’s heart condition could be clarified. Towards
this end, a new VA cardiology examination was conducted in
January 1996.
Following this examination, the VA cardiologist issued his
report in February 1996. This report made it clear that the
VA cardiologist noted the medical findings from 1985, 1986,
1988, 1991 and 1995 when he made his medical diagnosis. In
fact, the VA cardiologist specifically opined that although
the October 1995 electrocardiogram was computer read as
showing an ST abnormality, his reading of the ST segments
were that they were normal. After reviewing these medical
records, and conducting his own examination, the VA
cardiologist concluded that the veteran does not currently
have coronary artery disease.
Based upon this report, the RO denied service connection for
ischemic heart disease secondary to service-connected
beriberi in a February 1996 rating decision. The veteran
appealed this decision to the Board.
Service connection may be granted for a disability resulting
from disease or injury incurred in or aggravated by service.
38 U.S.C.A. § 1110; 38 C.F.R. § 3.303 (1997). Service
connection may be granted for any disease or injury diagnosed
after discharge, when all of the evidence establishes that
the disease or injury was incurred in service. 38 C.F.R. §
3.303(d). In the case of a veteran who is a former POW and
who was interned or detained for not less than 30 days,
certain diseases which become manifest to a degree of 10
percent or more after active military service shall be
considered to have been incurred in service, notwithstanding
that there is no record of such disease during service.
Among the diseases are beriberi heart disease, which includes
ischemic heart disease if the former POW experienced
localized edema while in captivity. 38 U.S.C.A. § 1112; 38
C.F.R. § 3.309(c).
The medical evidence from October 1988, December 1994,
September 1995, and February 1996 consistently show that the
veteran did not have an active heart disorder. None of the
private medical records submitted in support of the veteran’s
claim contains a diagnosis of a heart disorder. Although the
veteran was treated in 1985 and 1986 for an aortic aneurysm,
the September 1995 VA examiner clearly stated that one does
not automatically mean that the other is also present. The
two conditions are associated with each other, but not
directly related. Similarly, the September 1995 VA examiner
pointed out that having beriberi during service does not per
se mean that heart disease will develop. The only medical
evidence of an active heart disorder was in the October 1995
POW examination, which diagnosed generalized arteriosclerosis
with ischemic heart disease. This diagnosis is contradicted
by the remaining medical evidence, including the
contemporaneous radiologist’s report and the subsequent
cardiologist’s report in February 1996. The radiologist’s
report stated that there was no evidence of active pulmonary
disease or signs of congestive failure. The February 1996
cardiologist’s report reviewed the October 1995 findings, and
stated that the veteran did not currently have coronary
artery disease. Additionally, it was the opinion of the
February 1996 VA cardiologist that the October 1995
electrocardiogram finding was mistaken. Furthermore, the
October 1995 examiner’s diagnosis was based, at least in
part, on a reported diagnosis of heart disease nine years
earlier. Consequently, the October 1995 diagnosis is without
merit as it is based, at least in part, on an inaccurate
medical history. See Owens v. Brown, 7 Vet.App. 429, 433
(1995); see also Reonal v. Brown, 5 Vet.App. 458, 461 (1993).
As the persuasive medical evidence shows that the veteran
does not have a current heart disorder, the Board cannot
grant service connection.
Total Disability for Individual Unemployability
In March 1996, the veteran submitted his Application for
Increased Compensation Based on Unemployability. In this
application, the veteran stated that his last five years of
employment was with the Standard Insurance Company from 1981
to 1986. He stated that his disabilities prevented him from
working full-time beginning in April 1986.
As already stated, the veteran currently has a combined
disability rating of 80 percent based upon the following:
PTSD, evaluated as 30 percent disabling; arthritis, cervical
spine, with limitation of motion, evaluated as 20 percent
disabling; beriberi with malnutition, muscle fatigue,
hypoactive triceps and biceps, evaluated as 20 percent
disabling; bursitis, left shoulder, with degenerative joint
disease, evaluated as 20 percent disabling; bursitis of the
right shoulder, evaluated as 20 percent disabling; and
traumatic arthritis of the lumbar spine, evaluated as 20
percent disabling.
The private medical records from December 1985 lists the
veteran as having retired the past January. The veteran
reported that he retired because he had been “slowing
down,” and feeling a little more tired than usual during the
past six to twelve months. There was no medical opinion as
to whether or not these symptoms were due to the veteran’s
service-connected disabilities.
In conjunction with the veteran’s August 1994 claim for
benefits, a Social and Industrial Survey was conducted in
September 1995. The veteran’s claim file was available for
review when the Survey was conducted, but his medical file
was not. The veteran reported trouble sleeping, waking up
several times during the night. He reported having
nightmares three to four times a month, and intrusive
thoughts of POW experiences about three to four times per
week. However, he was attending group meetings with other
former-POWs which he stated has been helpful Regarding his
post-service employment history, the veteran reported that
upon discharge he went back to school and received an
Associate of Arts degree in accounting. He went into the
cleaning business for a year, until he developed a back
problem and decided to sell out. He went to work as an
accountant with a local business for between one to two
years, resigned due to feeling cooped up and claustrophobic.
He went to selling cars for two years, and resigned this
occupation to enter into the life insurance business. He
reportedly retired in 1986, but indicated that he still
maintained “a low level of activity as an insurance agent.”
Overall, the social worker assessed that the veteran’s PTSD
was manifest by chronic problems with sleep, nightmares,
intrusive thinking, episodes of depression and feelings like
he does not want to live. Moreover, the veteran experiences
ongoing significant physical and medical problems and seems
to worry about his medical status. There was no indication
of delusions, hallucinations, suicidal or homicidal ideation
or bizarre behavior. No opinion was given as to whether or
not the extent of the veteran’s service-connected
disabilities prevented him from obtaining current, gainful
employment.
A contemporaneous PTSD examination was also conducted by the
VA examiner in September 1995. At this examination, the
veteran reported his past occupational history as including
seventeen years at the Equitable Life Insurance Company, and
then twenty years at Standard Life Insurance Company. The
veteran reported that he retired from Standard Life in 1986,
but continued working with the company for several additional
years on a commission basis. His income during those years
was apparently minimal. The veteran reportedly relinquished
his license in 1995. His current income was reported as
Social Security benefits, his service-connected disability
benefits, and a very small amount that he received from the
Insurance Company. The examiner opined that the veteran’s
level of functioning worsened after his retirement, due to
the fact that he has stayed home and has more time to dwell
in the past. The examiner also opined that the veteran’s
geographic adjustment factor(s) was probably around 60.
The October 1995 POW examination shows that the veteran could
not manage one of his chosen occupations of accountant
because of claustrophobia, but this was felt to be due to
PTSD. No opinion was given as to whether or not the extent
of the veteran’s service-connected disabilities prevented him
from obtaining current, gainful employment.
In August 1996, Standard Insurance Company confirmed that the
veteran had been employed with their firm from February 1970
to April 1996. They reported that he began receiving monthly
retirement benefits in July 1985, and that these benefits
will continue for the remainder of the veteran’s life.
The RO denied entitlement to individual unemployability in a
September 1996 rating decision. The RO stated that the
veteran reported that he worked for Standard Insurance from
1981 to 1986, but the report from the firm stated he worked
there for over twenty-six years. This report also shows that
the veteran retired in April 1996, but did not indicate that
retirement was due to disability, or that there was any time
lost due to disability, or that any concessions were made by
reason of disability. Based upon the evidence, the RO
concluded that the veteran apparently retired after a long
career as an insurance salesman due to length of service
rather than disability. Thus, the RO concluded that
entitlement to individual unemployability should be denied
because the veteran was not found to be unable to secure or
follow a substantially gainful occupation as a result of
service-connected disabilities.
The veteran submitted his notice of disagreement in October
1996. In this correspondence, the veteran stated that he
honestly answered the question about his employment since the
Application form required him to list the “Last Five Years
You Worked.” He found it “disgusting” that the RO’s
rating decision implied that he did not answer honestly.
Furthermore, he states that he left Standard Insurance
because of the stresses the insurance business causes and the
way it affected his PTSD and other service-connected
disabilities. Also, it was impossible for him to find
current gainful employment.
In its October 1996 statement of the case, the RO reiterated
its conclusion from the September 1996 rating decision.
However, the RO made it a point to assure the veteran that it
did not mean to imply he had lied about his employment
history. All it intended was to inform the veteran of the
information received from Standard Insurance so that he would
be fully aware of what was considered in reaching its
decision on the veteran’s claim.
To warrant a total rating based on individual
unemployability, the veteran’s service-connected disabilities
must be severe enough, in light of his educational background
and employment history, to render him unable to secure and
follow a substantially gainful occupation. 38 C.F.R. §§
3.340, 3.341, 4.16.
Total disability ratings for compensation may be assigned
where the schedular rating for the service-connected
disability or disabilities is less than 100 percent when it
is found that the disabled person is unable to secure or
follow a substantially gainful occupation as a result of a
single service-connected disability ratable at 60 percent ore
more, or as a result of two or more disabilities, provided at
least one disability is ratable at 40 percent or more, and
there is sufficient additional service-connected disability
to bring the combined rating to 70 percent or more. Multiple
disabilities resulting from a common etiology or a single
accident are considered one disability. 38 C.F.R. § 4.16(a).
At first glance, it does appear that the veteran clearly
fails to meet the schedular criteria for a total disability
rating for compensation as he does not have any disability
ratable at 40 percent or more. 38 C.F.R. § 4.16(a).
However, the regulation goes on to state that for the
purposes of finding one 60 percent disability, or one 40
percent disability in combination, multiple disabilities
incurred as a POW will be considered as one disability.
38 C.F.R. § 4.16(a)(5). The veteran’s beriberi, evaluated as
20 percent disabling, was a condition he incurred while being
held as a POW. His PTSD, evaluated as 30 percent disabling,
is manifest by recurrent nightmares and intrusive thoughts of
when he was held as a POW. The remaining compensable ratings
are for various manifestations of traumatic arthritis.
Service connection was granted for these conditions in the
December 1995 rating decision under the POW presumptions
found under 38 C.F.R. § 3.309(c). Therefore, the Board
concludes that evidence shows that the veteran’s combined
disability rating of 80 percent are all for disabilities the
veteran incurred as a POW. Consequently, the 80 percent
disability rating is to be considered one rating for the
purpose of determining whether the veteran is entitled to a
total disability rating for individual unemployability under
38 C.F.R. § 4.16(a)(5).
The question in the instant case is now whether the veteran’s
service-connected disabilities prevents him from pursuing
substantial gainful employment. In making this
determination, the Board finds that while the veteran did
have a long history of employment since his discharge, his
last ten years of employment (1986 to 1996) were, at most,
only part-time work. Moreover, the veteran’s income for this
period was apparently minimal. Therefore, the Board
concludes that the veteran only had marginal employment
during the last ten years that he worked (1986 to 1996).
Marginal employment is not considered substantially gainful
employment for the purposes of evaluating a total
unemployability claim. 38 C.F.R. § 4.16.
The veteran has contended that he retired in 1986 because the
severity of his service-connected disabilities significantly
impaired his ability to continue working full-time. Further,
he contends that these service-connected disabilities also
prevent him from obtain current gainful employment. As there
is no evidence specifically refuting these contentions, the
Board finds that the evidence is, at least, in equipoise
regarding the validity of contentions. Consequently, the
rule on reasonable doubt requires that the Board finds in
favor of the veteran, and the contention is presumed to be
true. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102.
Based on the foregoing, the Board finds that the
preponderance of the evidence shows that the veteran only had
marginal employment from 1986 to 1996, that his service-
connected disabilities forced him to retire from full-time
employment, and currently prevent him from obtaining
substantially gainful employment. Therefore, the Board
concludes that the criteria for a total rating based on
individual unemployability has been met. 38 U.S.C.A. §
5107(a); 38 C.F.R. §§ 3.321, 3.340, 3.341, 4.16.
ORDER
1. Entitlement to service connection for a heart disorder is
denied.
2. Entitlement to a total rating for compensation based on
individual unemployability is granted.
JOHN E. ORMOND, JR.
Member, Board of Veterans' Appeals
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West
1991 & Supp. 1997), a decision of the Board of Veterans'
Appeals granting less than the complete benefit, or benefits,
sought on appeal is appealable to the United States Court of
Veterans Appeals within 120 days from the date of mailing of
notice of the decision, provided that a Notice of
Disagreement concerning an issue which was before the Board
was filed with the agency of original jurisdiction on or
after November 18, 1988. Veterans' Judicial Review Act,
Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The
date which appears on the face of this decision constitutes
the date of mailing and the copy of this decision which you
have received is your notice of the action taken on your
appeal by the Board of Veterans' Appeals.
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